目的 观察高位结扎联合腔内激光治疗大隐静脉曲张的疗效。 方法 回顾性分析2008年4月-2009年4月采用高位结扎联合腔内激光治疗32例大隐静脉曲张患者的临床资料，并与2003年-2008年采用传统手术方法治疗的61例患者进行对照分析。 结果 采用高位结扎联合腔内激光治疗的患者1例伤口感染，1例手术后患肢疼痛，3例手术后3个月局部轻度曲张；其余患者下肢症状减轻或消失，手术后1个月复查时活动均无障碍，无下肢深静脉血栓形成，无下肢深静脉损伤发生。高位结扎联合腔内激光治疗与传统手术方法比较具有切口少、出血量小、手术时间短、恢复快、住院时间短、手术后并发症较少、复发率低等优点。 结论 高位结扎联合腔内激光治疗大隐静脉曲张是一种安全有效的治疗方法，与传统手术比较具有明显优势。
目的 总结单纯性大隐静脉曲张的治疗经验。方法 回顾性分析我院2007年3月至2009年11月期间采用改进高位结扎及剥脱术治疗单纯性大隐静脉曲张65例患者的临床资料。结果 本组患者手术时间45～127 min，平均54 min。住院时间5～8 d，平均6.8 d。所有切口均甲级愈合，肿胀不适、沉重感等症状消失，切口皮下无出血、瘀血、血肿，无皮肤麻木等并发症发生。术后随访2～33个月，平均26.9个月，无一例发生深静脉血栓形成，均按期拆线，效果良好，无复发。结论 改进高位结扎剥脱术治疗单纯性大隐静脉曲张疗效确切。
ObjectiveTo observe the efficiency of endovenous laser therapy combined with planning sucking operation in the treatment of great saphenous varicose veins. MethodsTotally 48 patients (60 limbs) were treated from May 2011 to May 2014 in general surgery department of our hospital. The main trunk of great saphenous vein was ablated by endovenous laser treatment; and the varicose veins in calf were resected by planning sucking operation. ResultsAll 48 patients (60 limbs) were cured without recurrent during 6-36 months followed-up. The operative time of each side was 18-43 min, the average operative time was 22.6 min; with 1-3 skin incisions. Hospital stay was 5-8 d, the average hospitalization time was 6.7 d. After operation, the varicose veins and the felling of swelling were disappeared, the pigmentation was reduced or disappeared. Local skin numbness showed in 6 cases and recovered in 3-7 months after operation. Felling of burns appeared in 2 cases, and was healed after treatment. Ankle swelling presented in 5 cases, and released in 6-13 d with related treatment. Different degree of subcutaneous bruising appeared without any hematoma, and recovered in 2-4 weeks. Two cases were lost during the followed-up. ConclusionsEndovenous laser therapy combined with planning sucking operation is safe and effective in the treatment of great saphenous varicose. It is worthy of promotion with minimum damage, less pain, fast recovery, no scars, shorter operative time, and shorter hospital stay.
ObjectiveTo systematically review the effectiveness and safety of laparoendoscopic single-site surgery (LESS) for varicocele. MethodsSuch databases as The Cochrane Library, MEDLINE, EMbase, CBM, CNKI, and WanFang Data were electronically searched for studies about LESS and traditional laparoscopy for varicocele till March 1st, 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.1 software. ResultsSeven RCTs involving 452 cases were included. The results of meta-analysis showed that, there was no significant difference between LESS and traditional laparoscopy for varicocele on post-operational complications (RR=0.57, 95%CI 0.26 to 1.27, P=0.17), duration of hospital stay (MD=-0.30, 95%CI-0.87 to 0.26, P=0.30), improvement of semen parameters, and blood loss. However, LESS had longer duration of operation (MD=11.26, 95%CI 3.62 to 18.90, P=0.004). ConclusionThe effectiveness and safety of LESS and traditional laparoscopy for varicocele are similar, and LESS could achieve more beautiful and natural effects which has longer surgery time on account of non-proficiency in surgery and equipment. Due to the limited quantity and quality of the included studies, the above conclusion requires to be proved by more high quality randomized controlled trials.
目的:探讨经腹腔修补术治疗小儿复发性斜疝的安全性和疗效。方法:总结分析了我院2005年4月至2009年3月30例经腹腔修补小儿复发性斜疝手术的临床资料。30例患儿均为男性,年龄(3.10±1.36)岁,全部证实为小儿腹股沟斜疝行疝囊高位结扎术后1年内复发仍为腹股沟斜疝者,其中包括嵌顿型斜疝4例。结果:30例患儿手术均获成功,平均手术时间(31.0±5.28)分,术中失血(10.85±4.56)mL,术后平均住院天数(6.5±1.38),术中均无精索及膀胱损伤,术后均无阴囊血肿及远端疝囊积液,术后随访至今,无一例复发。结论:经腹腔修补术治疗小儿复发性斜疝术具有术中出血少,损伤小,并发症少,术后复发率低等优点,是一种安全有效的治疗方式,值得基层医院推广。
Objective To compare the effect of high ligation and spot stripping (HLSS) and high ligation and foam sclerotherapy (HLFS) in the treatment of great saphenous varicose veins (GSVV). Methods A retrospective analysis was conducted on the clinical data of 385 patients with GSVV who received HLFS or HLSS treatment at Guizhou Provincial People’s Hospital from January 2018 to June 2022. The differences in surgical time, intraoperative bleeding, complications, and postoperative hospital stay between the two groups were compared. Results The surgical time, intraoperative bleeding, postoperative hospital stay, visual analog scale for pain, incidence of postoperative hematoma, skin sensory disorders, and infection in the HLFS group were less or lower than those in the HLSS group (P<0.05), but there was no statistically significant difference in recurrence rate between the two groups (P>0.05). Compared with preoperative indicators at the same group, the modified venous clinical severity score (VCSS) decreased and the chronic lower limb venous insufficiency questionnaire (CIVIQ) score increased (P<0.05). However, there was no statistically significant difference in the degree of improvement in VCSS and CIVIQ between the two groups at three months after surgery and before surgery (P>0.05). Conclusions HLFS has a definite therapeutic effect on GSVV, with smaller trauma, faster recovery after surgery, and lower incidence of postoperative complication compared to HLSS. It can be used as a surgical option for GSVV patients in clinical practice.
Objective To investigate the clinical value of laparoscopic high ligation of hernia sac with constructed veress needle in the treatment of indirect inguinal hernia in children. Methods Ninety-one cases of pediatric indirect inguinal hernia who received treatment in Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group from October 2014 to December 2015 were selected and randomly divided into two groups, cases of laparoscopy group (n=41) were treated by laparoscopic high ligation of hernia sac with constructed veress needle, and cases of tradition group (n=50) were treated with traditional open high ligation of hernia sac. Comparison of clinical effect between the 2 groups was performed. Results All the operations were successfully carried out, and there was no conversion to open surgery in laparoscopy group. Three cases were diagnosed as two-side inguinal hernia in laparoscopy group, who were diagnosed as one-side inguinal hernia before operation. The operation time, length of surgical incision, blood loss, and hospital stay of the laparoscopy group were all significantly less than those of the tradition group (P<0.05). The incidence of postoperative complications such as scrotal edema and scrotal hydrocele, incidence of testicular dysplasia, and the recurrence rate in the laparoscopy group were all significantly lower than those of the tradition group (P<0.05). Conclusions Laparoscopic high ligation of hernia sac with constructed veress needle in the treatment of indirect inguinal hernia in children has good application value, which has advantages of small surgical trauma, shorter hospital stay, faster recovery, and less postope-rative complications, and we can find out contralateral recessive hernia during operation and avoid the second surgery.
周围静脉疾病是临床上的常见病和多发病，其发病率为20%～40%，皮肤营养障碍占2%～5%［1，２］ ,发病率比动脉疾病约高10倍，发病机理比动脉疾病复杂，分类方法亦不一致，至今存在着争论。下肢慢性静脉功能不全（chronic venous insufficiency,CVI）按其病因可分为原发性、继发性及先天性; 按解剖范围可分为浅、深和交通静脉3个系统，亦即包括浅静脉曲张、深静脉瓣膜功能不全、深静脉血栓形成后遗症、交通静脉瓣膜功能不全等［３，４］。多年来下肢浅静脉曲张主张施行大隐静脉高位结扎加剥脱术，但术后复发者较多。近年来，随着国内、外学者对CVI的深入研究，尤其是对深静脉瓣膜功能不全的认识，使传统下肢浅静脉曲张的概念发生了根本转变。下肢浅静脉曲张已不再被认为是一个独立的疾病，而是一种可由多种不同病因引起的共同临床表现……